Identifying Natural Subgroups of Migraine Based on Profiles of Comorbidities and Concomitant Conditions: Results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (P3.123)

Objective: To identify natural subgroups of migraine based on profiles of comorbidities and concomitant conditions (CCCs).

Background: Migraine is a heterogeneous disease. Identifying natural subgroups (endophenotypes) may facilitate biological and genetic characterization and individualization of treatment.

Design/Methods: The CaMEO Study is a prospective web-based survey study designed to characterize the course of migraine and related comorbidities in a systematic US sample of people meeting modified ICHD-IIIβ criteria. Respondents were asked if they ever had a specific condition/symptom and, if present, if the symptom/condition was confirmed/diagnosed by a “doctor”; 62 CCCs were available for analysis. Latent class analysis (LCA) modeling determined the optimal number of classes and a parsimonious set of CCCs.

Results: Of the 12,810 respondents, 11,837 reported ≥1 CCC and were included in this analysis. An 8-class model was identified containing 22 comorbidities/variables. Each class had a distinct CCC pattern, characterized as follows: Class 1, many CCCs; Class 2, respiratory/psychiatric; Class 3, respiratory/pain; Class 4, respiratory; Class 5, psychiatric; Class 6, cardiovascular; Class 7, pain; Class 8, few CCCs. The distribution of individuals across models was variable with one-third of respondents in Class 8 (few CCCs) and <10% in Class 1 (many CCCs). Demographic and clinical characteristics varied across classes. For example, compared to members of Class 8 (few CCCs), members of Class 1 (many CCCs) had a greater proportion of individuals with grade IV (severe disability) MIDAS (48.1% vs 22.3% of overall individuals), and higher rates of allodynia (67.6% vs 47.0%), medication overuse (36.4% vs 15.0%), CM (23.1% vs 9.1%), and aura (40.1% vs 28.8%).

Conclusions: LCA modelling identified 8 underlying patterns of comorbid health problems among people with migraine. These classes show differences in headache features and treatment patterns not used to form the classes. Subsequent research will assess prognostic differences among the classes.

Study Supported by: Allergan plc

Disclosure: Dr. Lipton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Has reviewed for the NIA and NINDS, serves as consultant, advisory board member, or has received honoraria from: Alder, Allergan, Amgen, Autonomic Technologies, Avanir, Boston Scientific, Dr. Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmit. Dr. Lipton has received royalty, license fees, or contractual rights payments from Receives royalties from Wolff’s Headache, 8th Edition, Oxford University Press, 2009 and Informa. Dr. Lipton holds stock and/or stock options in Holds stock options in eNeura Therapeutics and Biohaven. Dr. Lipton has received research support from Support from the NIH, the Migraine Research Foundation, the National Headache Foundation, Allergan plc, Amgen, Dr Reddy’s, and Novartis. Dr. Fanning has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Vedanta Research. Dr. Fanning has received research support from An employee of Vedanta Research, which has received research funding from Allergan, Amgen, Dr. Reddy’s Laboratories, Eli Lilly, GlaxoSmithKline, Merck & Co., Inc., and Novartis, via grants to the National Headache Foundation. Dr. Buse has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Avanir, Amgen, Biohaven, Eli Lilly and Company and Promeius. Dr. Martin has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Consultant for Amgen, Alder, Avenir and Supernaus; speaker for Allergan, Avenir and Depomed. Dr. Martin has received research support from Received support from a PCORI grant. Dr. Reed has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Vedanta Research. Dr. Reed holds stock and/or stock options in Vedanta Research, which sponsored research in which Dr. Reed was involved as an investigator. Dr. Reed has received research support from Managing Director of Vedanta Research, which has received research funding from Allergan, Amgen, Dr. Reddy’s Laboratories, Eli Lilly, GlaxoSmithKline, Merck & Co., Inc., and Novartis, via grants to the National Headache Foundation. Vedanta Research ha. Dr. Manack Adams has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan plc. Dr. Manack Adams holds stock and/or stock options in Allergan plc, which sponsored research in which Dr. Manack Adams was involved as an investigator. Dr. Manack Adams holds stock and/or stock options in Allergan plc. Dr. Goadsby has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder Biopharmaceuticals, Allergan, Amgen, Electrocore, Eli-Lilly, eNeura, Novartis, Teva.